A COVID-19 "exit" strategy to end lockdown and reopen the economy

How can we return to work without spurring a second surge of coronavirus infection? Biologist Uri Alon shares a thought-provoking strategy: four days at work followed by 10 days of lockdown, a cycle that would exploit a weakness in the virus's biology and potentially cut its reproductive rate to a manageable level. Learn more about this approach -- which has already been adopted by both companies and countries -- and how it could be a key to reopening the economy responsibly. (This virtual conversation, hosted by head of TED Chris Anderson and science curator David Biello, was recorded on May 20, 2020.)

Chris Anderson: So our first speaker
gave a TED Talk at TEDGlobal

I think seven years ago.

His name is Professor Uri Alon,

at the Weizmann Institute of Science.

Now, he and his colleagues there
have come up with a powerful idea

that addresses this key question:

How on earth do we get back to work

without creating a second surge
of the infection?

Uri Alon, welcome to TED.

Uri Alon: Thank you.
Nice to be here again.

CA: It's great to see you again.

So, I guess the key to your idea

is this obsession with
the reproduction number R, R-naught.

If that number is less than one,

then fewer than one person
is infected by a typical person,

and eventually, the epidemic fades away.

People are worried that
as we come back to work,

R will shoot up above one again.

You have a suggestion
for how we might avoid that.

What is that suggestion?

UA: Exactly.

So, we are suggesting a strategy

that's based on a weak spot
based on the biology of the virus,

which is a cycle of work and lockdown.

It exploits the vulnerability of the virus
in that, when a person gets infected,

they're not infectious
for about three days.

So you don't infect others
for the first three days,

and after another two days,
on average, you get symptoms.

So we're proposing a strategy
which is four days of work

and then 10 days of lockdown,

and the next two weeks, again:
four days of work, 10 days of lockdown.

And that way, if a person
gets infected at work,

they reach their peak infectiousness
during lockdown, and that way,

they avoid infecting many others.

This restricts the viral transmission.

Also, just working four days
out of two weeks

restricts the amount of time
the virus gets to see many other people,

and that's a very powerful effect.

So everybody works on the same four days,

kids go to school on the same four days,

with all the measures
of social distancing and masks, etc,

and then there's a lockdown period.

CA: So if you take
the worst-case scenario,

where you come to work on a Monday morning
at the start of your four days,

and you're infected on the subway,
say, on the way to work,

the theory here is that even
by the end of that four days,

you're not really starting
to infect your coworkers?

UA: That's correct.

So you're infected on the subway,

and so for the first three days or so,
you're in your latent period,

you don't infect your coworkers,

you reach your peak
infectiousness at home,

there will be secondary
infections at home,

and people with symptoms
can self-quarantine,

and over the long run, you have
a reproduction number less than one,

so the epidemic,
if you continue these cycles,

will go away.

CA: I mean, is it frustrating

at the thought that people
are going to say,

"Wait -- I don't want
to infect people at home,

I'd rather infect people
at work than at home."

What's the response to that?

UA: Yes, absolutely.

So we have to consider the alternatives.

If you open up the economy
and there's a second wave,

you'll get all those infections anyway
during the lockdown that happens,

along with the devastating effects
on the economy, etc.

And so, in the long run,

if you do a cyclic strategy like this

but with a reproduction
number that's less than one,

you avoid, at least with these
mathematical models and considerations,

the much larger number of infections
you'd get if there's a second wave.

CA: Right. You're serving the needs
of your family by -- sorry, go on.

UA: Even people who are infected
don't infect everyone at home.

The attack rates are 10 to 30 percent,
according to several studies.

CA: Right.

But the hope is that you're
serving the needs of your family

by engaging in a strategy
where very few of your fellow workers

are going to be infectious anyway,

so that's the plan, but um --

UA: That's right.

CA: Tell me this, though --
because four days out of 14,

someone's going to say, "Well, great idea,

but that implies, like,
a 70 percent loss of productivity

in the economy,

so that can't possibly work."

I think you think that
the productivity loss

need not be anything like that much.

UA: That's right,

and of course, most people
don't work weekends,

so it's four days out of
the 10 work days in the two weeks,

and once you have
a predictable schedule

of four days at work,

you can work longer hours,

you can design shifts
and get higher productivity

by prioritizing in those four days

much more than 40 percent of the workdays.

CA: Yes, so talk through
how that could work.

I mean, let's imagine,
first of all, manufacturing,

which is currently shut down.

Is the implication here
that a manufacturer could set up

two, possibly even three,
shifts of four days,

maybe 35 hours or something of work
over those four days

and still get a lot of productivity,

basically, having the lines
almost running continuously that way?

UA: Exactly.

So this is a staggered
version of this idea,

where you take the population,
divide it into two groups or three groups.

Let's say one group works four days
and then 10 days of lockdown.

Then the other group kicks in.

This idea was proposed by colleagues
at Bar-Ilan University.

Then you get an added benefit
that during workdays there's less density.

If there's two groups,

there's half the density
and less transmission.

And you can keep production lines
working almost continuously like that

using this staggered idea.

CA: And applying it to thinking
about offices coming back --

I mean, it seems to me that,
as we've already seen,

there's a lot of productivity
that can happen when you're at home,

so you could picture on this idea
of people doing one set of things

during the four days when they're,
say, back at the office,

doing the exposure to each other,
sparking off each other,

the discussions, the brainstorming,
all that good stuff,

while at home, they're then
doing all the things

that we've been doing
the last few weeks,

kind of working solo.

How much have you thought about how that,

whether it's possible, effectively,
to divide work into different types

and actually use a strategy like this

to maintain almost full
or even better productivity?

UA: I agree -- for many sectors,
people work at home very effectively,

and we've heard from several industries

that productivity actually
went up during lockdown

and people working at home.

So if you have a schedule,
a [cyclic exit strategy]

you can restrict the amount,

or you can plan the work
where you need to be together

in a very effective way

with avoiding a lot of time lost,

if the person's work
can be more effective at home

and more effective at work
and get high productivity.

I should say that some sectors
really need to adjust,

like hotels, tourism, dining.

In several industries, this will require
more thought and adjusting.

But other industries are almost
built for ideas like this.

Maybe it's even something
you can consider after the epidemic,

because productivity can be
at least as high.

CA: I mean, I read this and I started
thinking about our own organization, TED,

and how, in many ways, you could argue
that could work really well.

I mean, for one thing,

there's this question
about extroverts and introverts.

Some introverts, if they were honest,

might say that this pandemic
has been manna from heaven for them.

They've found work less stressful.

They've been able to focus and so forth.

With this sort of four days on,
four days off type strategy,

perhaps you can imagine a work world

that's optimized for both
introverts and extroverts?

UA: Absolutely.

I mean, I feel it also.

Me and my partner,
with different personalities,

we both teach in universities,

and teaching through this

has [helped me] become
productive in certain ways.

So I agree completely,

and I think harnessing the creativity
of people at workplaces,

we're only at the beginning
of what these kinds of mixtures can offer.

CA: But for people who are
on the front line,

again, if you're delivering
goods and so forth

and you can't do that virtually,

is there any thought about

how a four days on
and then isolation strategy,

how that off time could be used

to nonetheless contribute
to that person's work

through some form of training?

Or is it more just that people would work
very intensely during four days,

and maybe people still aren't quite
earning their full pay in this scenario,

but it's better than complete lockdown,

and it's better than going back to work
and seeing another surge?

UA: That's right.

So on a society level,

it's better than opening up
and seeing another surge,

which would require complete lockdown.

For people like hospital shifts,

some hospitals adopted
this kind of program

so we can protect shifts and avoid mixing.

It also creates a lot
of simplicity and clarity.

So you understand when you're working,

and you have some confidence because
this is based on scientific modeling

about the effectiveness of this plan.

It's also equitable in the sense
that everybody gets to go to work,

not only certain sectors,

it's transparent, etc.

[Cross talk]

CA: And this is something
that is best implemented

by individual companies?

Or is it actually much better
implemented a city at a time

or even a nation at a time?

UA: We think it can work [in levels].

So at certain companies,
it's very natural to adopt,

or at hospitals, schools, etc.

It can also work at the level
of a town or a region,

and then we would advise
trying it out for something like a month,

seeing whether cases rise.

In that case, you can dial down
the number of workdays.

Or, if cases are declining quickly,
you can add workdays

and therefore adapt to the climate
and the location where a person is.

So it's quite adaptable.

CA: But by aligning work schedules
with schools, for example,

that suddenly allows parents
to go back to work

on the days that their kids are at school,
and you'd have to try --

UA: Absolutely.

CA: I mean, is the best
instantiation of this

that countries literally divide households

into different A and B categories,
or something like that,

so that that kind
of alignment could happen?

UA: Exactly.

So you can align different
households, Group A and Group B,

and then the children go to school,
the parents go to work

in a synchronized way,

and the other group,
let's say, the alternating weeks.

A certain amount of people
need to work all the time.

Maybe teachers are, like, essential
workers and need to work throughout.

Just like during lockdown situations,

a certain fraction of the population
still works throughout.

But a region that does this
should be protected, in a sense,

because it has a replication
number of less than one,

so imported infections
also can't spread very much.

CA: And here is the aforementioned
David Biello. David.

David Biello: Yes. Hello, everybody.

Uri, as you can imagine,
there are lot of questions

from the audience,

and we have a first one

kind of about those workers
who have been marked as essential.

Can you comment on how this would impact
the health care professionals and others

who may not have time
or the flexibility to quarantine

in the way you suggest.

UA: That's great.

I want to say that
there's essential workers,

there's people with low income,
that just can't adhere to lockdown

because they have to make a living.

And studies show that mobility
[among] people in the low-income sectors

is larger during lockdown.

And also, in developing countries,
people just have to go out of the house.

You can't enforce lockdown.

So this four-10 kind of strategy can
actually make lockdown easier to bear

for people who can still
make a living during those days,

or at least make their own choices

about what fraction to work
and what fraction to stay in lockdown.

Some countries can't get
R less than one even with lockdown,

because of this adherence problem,
because of informal sectors, etc.

We believe that a four-10 cycle
might make it easier to do lockdown

and maybe get our infection
level less than one.

That affects billions
of people in the world.

I hope I answered your question.

DB: I think so,

and we have another question, I believe,

if that can be queued up,

which is:

Any chance you can do the math

and quantify the increased risk
of this four-10 cycle?

UA: So the increased risk,
we're saying in our scientific paper,

we did all the sensitivity analyses, etc,

and the question is, it's comparing
increased risk comparing to what?

So, to the economy ...

It's possible there will be a second wave.

I mean, I hope there won't be,
but it certainly is possible,

and in that case, it's clear
that a second wave and another lockdown

will have worse consequences on health

than a cycle of four-10.

And so it's really a question of
what you're comparing to.

DB: Sure.

Well, thank you so much
for sharing this idea, Uri.

CA: Indeed.

David, stay on.

But just before you go:

Have any governments
expressed interest in exploring this?

Do you see people considering
actually implementing this

as national policy?

UA: Yes, we're in touch
with several European countries

and countries in South America
and Israel, of course.

Austria has adopted a similar program
for their school system,

which is five school days every two weeks.

And several companies and hospitals, etc.

And so we're very interested
to see how this will play out.

CA: Well, I love the basic start point

of starting by looking
at the enemy's weakness.

And you've got this four-day period

where it's not necessarily
that dangerous after an infection,

if you could figure out
a way to work then.

I assume that testing would actually
enhance this idea as well a lot, right?

To test people before they come back --

UA: It's not predicated on testing.

You don't have to have
testing for this idea,

so that can apply to regions
without a lot of testing.

If you do have testing, it could help you
use testing in a more effective way

by concentrating testing on people
at the end of their 10 lockdown days,

just as they're about to go to work;

that could make
each test more impactful

in terms of reducing
their reproduction number.

CA: Indeed, instead of having
to test the whole population

every three or four days,

it's just once every two weeks.

That's a much more imaginable goal.

UA: Sure.

CA: Yeah.

Well, Uri Alon, thank you so much
for spending this time.